@article {Eroglue004417, author = {Zeynep Eroglu and Kristy K Broman and John F Thompson and Amanda Nijhuis and Tina J Hieken and Lisa Kottschade and Jeffrey M Farma and Meghan Hotz and Jeremiah Deneve and Martin Fleming and Edmund K Bartlett and Avinash Sharma and Lesly Dossett and Tasha Hughes and David E Gyorki and Jennifer Downs and Giorgos Karakousis and Yun Song and Ann Lee and Russell S Berman and Alexander van Akkooi and Emma Stahlie and Dale Han and John Vetto and Georgia Beasley and Norma E Farrow and Jane Yuet Ching Hui and Marc Moncrieff and Jenny Nobes and Kirsten Baecher and Matthew Perez and Michael Lowe and David W Ollila and Frances A Collichio and Roger Olofsson Bagge and Jan Mattsson and Hidde M Kroon and Harvey Chai and Jyri Teras and James Sun and Michael J Carr and Ankita Tandon and Nalan Akgul Babacan and Younchul Kim and Mahrukh Naqvi and Jonathan Zager and Nikhil I Khushalani}, title = {Outcomes with adjuvant anti-PD-1 therapy in patients with sentinel lymph node-positive melanoma without completion lymph node dissection}, volume = {10}, number = {8}, elocation-id = {e004417}, year = {2022}, doi = {10.1136/jitc-2021-004417}, publisher = {BMJ Specialist Journals}, abstract = {Until recently, most patients with sentinel lymph node-positive (SLN+) melanoma underwent a completion lymph node dissection (CLND), as mandated in published trials of adjuvant systemic therapies. Following multicenter selective lymphadenectomy trial-II, most patients with SLN+ melanoma no longer undergo a CLND prior to adjuvant systemic therapy. A retrospective analysis of clinical outcomes in SLN+ melanoma patients treated with adjuvant systemic therapy after July 2017 was performed in 21 international cancer centers. Of 462 patients who received systemic adjuvant therapy, 326 patients received adjuvant anti-PD-1 without prior immediate (IM) CLND, while 60 underwent IM CLND. With median follow-up of 21 months, 24-month relapse-free survival (RFS) was 67\% (95\% CI 62\% to 73\%) in the 326 patients. When the patient subgroups who would have been eligible for the two adjuvant anti-PD-1 clinical trials mandating IM CLND were analyzed separately, 24-month RFS rates were 64\%, very similar to the RFS rates from those studies. Of these no-CLND patients, those with SLN tumor deposit \>1 mm, stage IIIC/D and ulcerated primary had worse RFS. Of the patients who relapsed on adjuvant anti-PD-1, those without IM CLND had a higher rate of relapse in the regional nodal basin than those with IM CLND (46\% vs 11\%). Therefore, 55\% of patients who relapsed without prior CLND underwent surgery including therapeutic lymph node dissection (TLND), with 30\% relapsing a second time; there was no difference in subsequent relapse between patients who received observation vs secondary adjuvant therapy. Despite the increased frequency of nodal relapses, adjuvant anti-PD-1 therapy may be as effective in SLN+ pts who forego IM CLND and salvage surgery with TLND at relapse may be a viable option for these patients.Data are available on reasonable request.}, URL = {https://jitc.bmj.com/content/10/8/e004417}, eprint = {https://jitc.bmj.com/content/10/8/e004417.full.pdf}, journal = {Journal for ImmunoTherapy of Cancer} }